Diagnosis

Your family doctor or pediatrician can diagnose meningitis based on a medical history, a physical exam and certain diagnostic tests. During the exam, your doctor may check for signs of infection around the head, ears, throat and the skin along the spine.

You or your child may undergo the following diagnostic tests:

  • Blood cultures. Blood samples are placed in a special dish to see if it grows microorganisms, particularly bacteria. A sample may also be placed on a slide and stained (Gram's stain), then studied under a microscope for bacteria.
  • Imaging. Computerized tomography (CT) or magnetic resonance (MR) scans of the head may show swelling or inflammation. X-rays or CT scans of the chest or sinuses may also show infection in other areas that may be associated with meningitis.
  • Spinal tap (lumbar puncture). For a definitive diagnosis of meningitis, you'll need a spinal tap to collect cerebrospinal fluid (CSF). In people with meningitis, the CSF often shows a low sugar (glucose) level along with an increased white blood cell count and increased protein.

    CSF analysis may also help your doctor identify which bacterium caused the meningitis. If your doctor suspects viral meningitis, he or she may order a DNA-based test known as a polymerase chain reaction (PCR) amplification or a test to check for antibodies against certain viruses to determine the specific cause and determine proper treatment.

Treatment

The treatment depends on the type of meningitis you or your child has.

Bacterial meningitis

Acute bacterial meningitis must be treated immediately with intravenous antibiotics and, more recently, corticosteroids. This helps to ensure recovery and reduce the risk of complications, such as brain swelling and seizures.

The antibiotic or combination of antibiotics depends on the type of bacteria causing the infection. Your doctor may recommend a broad-spectrum antibiotic until he or she can determine the exact cause of the meningitis.

Your doctor may drain any infected sinuses or mastoids — the bones behind the outer ear that connect to the middle ear.

Viral meningitis

Antibiotics can't cure viral meningitis, and most cases improve on their own in several weeks. Treatment of mild cases of viral meningitis usually includes:

  • Bed rest
  • Plenty of fluids
  • Over-the-counter pain medications to help reduce fever and relieve body aches

Your doctor may prescribe corticosteroids to reduce swelling in the brain, and an anticonvulsant medication to control seizures. If a herpes virus caused your meningitis, an antiviral medication is available.

Other types of meningitis

If the cause of your meningitis is unclear, your doctor may start antiviral and antibiotic treatment while the cause is determined.

Chronic meningitis is treated based on the underlying cause. Antifungal medications treat fungal meningitis and a combination of specific antibiotics can treat tuberculous meningitis. However, these medications can have serious side effects, so treatment may be deferred until a laboratory can confirm that the cause is fungal. Chronic meningitis is treated based on the underlying cause.

Noninfectious meningitis due to allergic reaction or autoimmune disease may be treated with corticosteroids. In some cases no treatment may be required, because the condition can resolve on its own. Cancer-related meningitis requires therapy for the individual cancer.

Preparing for your appointment

Meningitis can be life-threatening, depending on the cause. If you've been exposed to bacterial meningitis and you develop symptoms, go to an emergency room and let medical staff know you may have meningitis.

If you're not sure what you have and call your doctor for an appointment, here's how to prepare for your visit.

What you can do

  • Be aware of any pre- or post-appointment restrictions. Ask if there's anything you need to do in advance, such as restrict your diet. Also ask if you may need to stay at your doctor's office for observation following your tests.
  • Write down symptoms you're having, including changes in your mood, thinking or behavior. Note when you developed each symptom and whether you had cold or flu-like symptoms.
  • Write down key personal information, including any recent moves, vacations or interactions with animals. If you're a college student, your doctor likely will ask questions about any similar signs or symptoms in your roommates and dorm mates. Your doctor will also want to know your vaccination history.
  • Make a list of all medications, vitamins or supplements you're taking.
  • Take a family member or friend along. Meningitis can be a medical emergency. Take someone who can help remember all the information your doctor provides and who can stay with you if needed.
  • Write down questions to ask your doctor.

For meningitis, some basic questions to ask your doctor include:

  • What kinds of tests do I need?
  • What treatment do you recommend?
  • Am I at risk of long-term complications?
  • If my condition is not treatable with antibiotics, what can I do to help my body recover?
  • Am I contagious? Do I need to be isolated?
  • What is the risk to my family? Should they take preventive medication?
  • Is there a generic alternative to the prescription medicine you're recommending?
  • Do you have any printed information I can have? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

  • When did you begin experiencing symptoms?
  • How severe are your symptoms? Do they seem to be getting worse?
  • Does anything seem to improve your symptoms?
  • Have you been exposed to anyone with meningitis?
  • Does anyone in your household have similar symptoms?
  • What is your vaccination history?
  • Do you take any immunosuppressant medications?
  • Do you have other health problems, including allergies to any medications?

What you can do in the meantime

When you call your doctor's office for an appointment, describe the type and severity of your symptoms. If your doctor says you don't need to come in immediately, rest as much as possible while you're waiting for your appointment.

Drink plenty of fluids and take acetaminophen (Tylenol, others) to reduce your fever and body aches. Also avoid any medications that may make you less alert. Don't go to work or school.